Introduction

Pain, unrelieved by the analgesics aspirin and ibuprofen, is estimated to affect 30 to 40 million Americans annually.  Further, according to the American Medical Association, 13 to 15 million Americans suffer from chronic, intractable and severe pain, most of which is inadequately treated Undertreatment occurs in both hospital and out-patient settings. The principal reasons treatment is inadequate for both short-term and chronic pain are thought to be 1) patient reluctance to take medications out of fear of addiction; 2) patient reluctance to report pain; 3) physician concerns about the side effects of opiate-derived medications; 4) poor physician assessment of pain; 5) physician fear of patient addiction; 6) inadequate physician knowledge of pain management; 7) unavailability of pain treatment programs and facilities; 8) inadequate third-party reimbursement for pain treatment; 9) low priority for pain treatment; 10) restrictive regulation of controlled substances.

It has been estimated that as many as 90% of the patients involved in assisted suicide by Dr. Kervorkian are chronic, severe, intractable pain patients3. Considering that modern pain management techniques are available which would be effective in relieving virtually every pain case,4 the under treatment of pain, and its lethal consequences, presents one of the most urgent issues in contemporary medicine. The recent announcement of clinical trials by Abbott Pharmaceuticals of its drug ABT-5945, derived from epibatidine, obtained from the skin of the Ecuadorian frog Epilbpedoates tricolor, represents a critical change in the history of the treatment of pain. Said to be 200 times more effective in relieving pain than morphine, the derivative promises to effectively relieve pain with none of the deleterious side effects of morphine, such as tolerance, constipation, cholinergic effects on vision, etc. The clinical availability of this drug awaitscase4 , the under treatment of pain, and its lethal consequences, presents one of the most urgent issues in contemporary medicine. The recent announcement of clinical trials by Abbott Pharmaceuticals of its drug ABT-5945, derived from epibatidine, obtained from the skin of the Ecuadorian frog Epilbpedoates tricolor, represents a critical change in the history of the treatment of pain. Said to be 200 times more effective in relieving pain than morphine, the derivative promises to effectively relieve pain with none of the deleterious side effects of morphine, such as tolerance, constipation, cholinergic effects on vision, etc. The clinical availability of this drug awaits successful clinical trials and FDA approval. It is conservative to conclude, however, that even if the drug fails to win approval for clinical use, drugs specifically designed to singularly effect cellular pain receptor sites are on the near horizon. Regardless, the phenomenon of opiophobia 6 in the prescriptive practices of North American physicians is not likely to disappear without extensive educational activities amongst both physicians and patients.

Toward the goal of meeting these educational needs, this statement is intended to review the critical factors involved in the safe and effective use of opiate-derived medications in the successful treatment of pain without iatrogenic complications.